More Than One-Quarter of Insured Adults Were Underinsured in 2016

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Marlene Johns
5 years ago
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Exhibit 1 More Than One-Quarter of Insured Adults Were Underinsured in 216 Percent adults ages 19 64 insured all year who were underinsured* 28 22 23 23 2 12 13 1 23

income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income.

1 Exhibit 1 More Than One-Quarter of Insured Adults Were Underinsured in 216 Percent adults ages insured all year who were underinsured* * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Surveys (23, 25, 21, 212, 214, and 216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

2 Exhibit 2 Underinsured Rates by Source of Coverage Percent adults ages insured all year who were underinsured* Total 12% 13% 22% 23% 23% 28% Insurance source at time of survey** Employer-provided coverage 1% 12% 17% 2% 2% 24% Individual coverage^ 17% 19% 37% % 37% 44% Marketplace^^ 44% Medicaid 22% 16% 32% 31% 22% 26% Medicare (under age 65, disabled) 39% 24% % 32% 42% 47% Firm size (base: full- or part-time workers with coverage through their own employer)^^^ 2 99 employees 14% 16% 26% 26% 22% 1 or more employees 11% 16% 16% 14% 22% * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. ** Adults with coverage through another source are not shown here. Respondents may have had another type of coverage at some point during the year, but had coverage for the entire previous 12 months. ^ For 214 and 216, includes those who get their individual coverage through the marketplace and outside of the marketplace. ^^ Adults enrolled in marketplace coverage are not shown for 214 because no one in the sample would have had marketplace coverage for the full year. ^^^ Does not include adults who are self-employed. Data not available. Data: Commonwealth Fund Biennial Health Insurance Surveys (23, 25, 21, 212, 214, and 216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

3 Exhibit 3 In Florida and Texas, One-Third of Insured Adults Were Underinsured in 216 Percent adults ages insured all year who were underinsured* All states California New York Florida Texas * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

4 Exhibit 4 Deductibles in Private Plans Have Grown over the Past Decade Percent adults ages with private coverage* No deductible $1 $999 $1, $2,999 $3, or more 13 Amount of deductible * Base is those who specified deductible. Data: Commonwealth Fund Biennial Health Insurance Surveys (23, 25, 21, 212, 214, and 216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

5 Exhibit 5 High Deductibles Relative to Income by Coverage Source Percent adults ages insured all year who had deductibles that were 5% or more of income Total 3% 3% 6% 8% 11% 12% Insurance source at time of survey* Employer-provided coverage 2% 2% 6% 8% 11% 13% Individual coverage^ 7% 12% 17% % 24% 23% Marketplace^^ 22% Firm size (base: full- or part-time workers with coverage through their own employer)^^^ 2 99 employees 4% 6% % 2% 13% 1 or more employees 1% 5% 6% 8% 13% * Respondents may have had another type of coverage at some point during the year, but had coverage for the entire previous 12 months. ^ For 214 and 216, includes those who get their individual coverage through the marketplace and outside of the marketplace. ^^ Adults enrolled in marketplace coverage are not shown for 214 because no one in the sample would have had marketplace coverage for the full year. ^^^ Does not include adults who are self-employed. Data not available. Data: Commonwealth Fund Biennial Health Insurance Surveys (23, 25, 21, 212, 214, and 216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

6 Exhibit 6 Underinsured Rates Highest Among Low-Income Adults and Those with Health Problems Percent adults ages insured all year who were underinsured* <2% FPL Fair/poor health status or any chronic condition** % FPL or more No health problem Notes: FPL refers to federal poverty level. Income levels are for a family of four in 216. * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. ** Respondent has at least one of the following health conditions: hypertension or high blood pressure; heart disease; diabetes; asthma, emphysema, or lung disease; or high cholesterol. Data: Commonwealth Fund Biennial Health Insurance Surveys (23, 25, 21, 212, 214, and 216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

7 Exhibit 7 More Than Half of Underinsured Adults Reported Medical Bill Problems, Close to Rate of Uninsured Percent adults ages Insured all year, not underinsured* Insured all year, underinsured* Uninsured during the year Had problems paying or unable to pay medical bills Contacted by collection agency for unpaid medical bills Had to change way of life to pay bills Medical bills being paid off over time 25 At least one medical bill problem or debt * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

8 Exhibit 8 Adults with High Deductibles Reported Problems Paying Medical Bills at Twice the Rate of Adults Without Deductibles Percent adults ages with private coverage who were insured all year No deductible Deductible $3, or more Had problems paying or unable to pay medical bills Contacted by collection agency for unpaid medical bills 18 Had to change way of life to pay bills Medical bills being paid off over time 21 At least one medical bill problem or debt Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

9 Exhibit 9 Adults with Medical Bill Problems Had Lingering Financial Problems Percent adults ages who reported the following happened in the past two years because of medical bill problems^ Insured all year, not underinsured* Insured all year, underinsured* Uninsured during the year Used all of savings Received a lower credit rating Took on credit card debt Took out a mortgage against your home or took out a loan Had to declare bankruptcy ^ Base: Respondents who reported at least one of the following medical bill problems in the past 12 months: had problems paying medical bills, contacted by a collection agency for unpaid bills, had to change way of life in order to pay medical bills, or has outstanding medical debt. * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

10 Exhibit 1 More Than Two of Five Underinsured Adults Reported Problems Getting Needed Care Because of Cost Percent adults ages Insured all year, not underinsured* Insured all year, underinsured* Uninsured during the year Had a medical problem, but did not go to a doctor or clinic Did not fill a prescription Skipped a medical test, treatment, or follow-up recommended by a doctor 7 Did not see a specialist when you or your doctor thought you needed to see one At least one cost-related access problem * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

11 Exhibit 11 Adults with High Deductibles Reported Problems Getting Needed Care Because of Cost Percent adults ages with private coverage who were insured all year No deductible Deductible $3, or more Had a medical problem, but did not go to a doctor or clinic Did not fill a prescription 8 Skipped a medical test, treatment, or follow-up recommended by a doctor 5 2 Did not see a specialist when you or your doctor thought you needed to see one 22 At least one cost-related access problem Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

12 Exhibit 12 Nearly a Quarter of Underinsured Adults with Health Problems Skimped on Medications or Got Care in a Hospital or Emergency Department Percent adults ages who have at least one health problem^ Insured all year, not underinsured* Insured all year, underinsured* Uninsured during the year Skipped doses or did not fill prescription for medications for health conditions because of the cost of the medicines 16 Stayed overnight in a hospital or visited the emergency department because of health condition 26 ^ Respondent has at least one of the following health conditions: hypertension or high blood pressure; heart disease; diabetes; asthma, emphysema, or lung disease; high cholesterol; depression or anxiety; chronic kidney disease or kidney failure; cancer, not including skin cancer; or a stroke. * Underinsured defined as insured all year but experienced one of the following: out-of-pocket costs, excluding premiums, equaled 1% or more of income; out-of-pocket costs, excluding premiums, equaled 5% or more of income if low-income (<2% of poverty); or deductibles equaled 5% or more of income. Data: Commonwealth Fund Biennial Health Insurance Survey (216). Commonwealth Fund Biennial Health Insurance Survey, 216, The Commonwealth Fund, October 217.

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